This document provides guidance on managing diabetes in patients with chronic kidney disease. It discusses epidemiology and the importance of glycemic control in slowing kidney disease progression. A case study is presented of a 65-year-old man with type 2 diabetes and stage 3 CKD, and appropriate HbA1c goals and measurement considerations are reviewed. Options for antihyperglycemic agents in CKD, including risks and benefits, are covered. Acute kidney injury is defined as a sudden reduction in renal function.
This document discusses guidelines for glycemic control in patients with diabetes and chronic kidney disease. It recommends monitoring HbA1c levels twice per year and targeting levels between 6.5-8%. Clinical trials showed that intensive glycemic control can reduce kidney disease progression but may increase mortality risk if targets are too low. The document also discusses guidelines for blood pressure control and the renoprotective effects of blocking the renin-angiotensin system with ACE inhibitors or ARBs. Combination therapy with an ACE inhibitor and ARB or adding an MRA may provide additional benefits but also increase risks like hyperkalemia.
This document discusses guidelines for glycemic control in patients with diabetes and chronic kidney disease. It recommends monitoring HbA1c levels twice per year and targeting levels between 6.5-8%. Clinical trials showed that intensive glycemic control can reduce kidney disease progression but may increase mortality risk if targets are too low. The document also discusses guidelines for blood pressure control and the renoprotective effects of blocking the renin-angiotensin system with ACE inhibitors or ARBs. Combination therapy with an ACE inhibitor and ARB or adding an MRA may provide additional benefits but also increase risks like hyperkalemia.
Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia. DM prevalence in Saudi Arabia is high at 23.7%. DM is diagnosed based on classic symptoms and elevated blood glucose levels. Prediabetes conditions like impaired fasting glucose and impaired glucose tolerance are risk factors for future diabetes and cardiovascular disease. Glycemic goals aim for an A1C below 7% and treatment involves medical nutrition therapy, oral medications, insulin, and preventing complications. Management of DM focuses on controlling blood glucose, blood pressure, lipids, and screening for and treating common complications.
The document discusses new trends in the management of diabetes in cardiac patients. It provides guidelines on glycemic targets and pharmacological therapy for type 2 diabetes. The recommended first-line treatment is metformin. Glycated hemoglobin (A1C) of less than 7% is a reasonable goal for many adults with diabetes, though some may require less or more stringent targets depending on individual factors. Combination therapy with oral medications and insulin is often needed to control blood sugar levels in type 2 diabetes.
- The prevalence of diabetes and prediabetes in India is estimated to be 9.3% and 24.5% respectively by 2022, with nearly half of those with diabetes unaware of their condition.
- Lifestyle interventions like achieving 7% weight loss through diet and exercise can reduce the risk of developing type 2 diabetes by 58%. Metformin and other drugs may also help prevent diabetes.
- Glycemic control is important and should be assessed regularly through A1C or other tests. An A1C under 7% is a reasonable goal for many adults to reduce health risks.
- Other comorbidities like hypertension, obesity, and kidney disease also need to be managed through lifestyle changes,
DKD is a leading cause of ESRD in the US, affecting 30-40% of those with diabetes. Poor glycemic control and hypertension are major risk factors for developing and progressing DKD. Clinical trials have shown that intensive control of blood glucose and blood pressure can delay and prevent kidney disease. New drugs targeting the kidney are showing promise in reducing albuminuria and slowing kidney function decline in DKD patients.
The document discusses the "glucose triad" which refers to the relationship between HbA1c, fasting plasma glucose, and postprandial plasma glucose in glycemic control. It notes that while HbA1c has traditionally been the target, more recent studies show intensive control to reach very low HbA1c levels may be detrimental. The document explores how the relationship between the components of the glucose triad changes over time as diabetes progresses, with postprandial glucose being more influential at lower HbA1c levels and fasting glucose becoming more important at higher levels. Treatment should target both fasting and postprandial hyperglycemia simultaneously for optimal control.
This document discusses guidelines for glycemic control in patients with diabetes and chronic kidney disease. It recommends monitoring HbA1c levels twice per year and targeting levels between 6.5-8%. Clinical trials showed that intensive glycemic control can reduce kidney disease progression but may increase mortality risk if targets are too low. The document also discusses guidelines for blood pressure control and the renoprotective effects of blocking the renin-angiotensin system with ACE inhibitors or ARBs. Combination therapy with an ACE inhibitor and ARB or adding an MRA may provide additional benefits but also increase risks like hyperkalemia.
This document discusses guidelines for glycemic control in patients with diabetes and chronic kidney disease. It recommends monitoring HbA1c levels twice per year and targeting levels between 6.5-8%. Clinical trials showed that intensive glycemic control can reduce kidney disease progression but may increase mortality risk if targets are too low. The document also discusses guidelines for blood pressure control and the renoprotective effects of blocking the renin-angiotensin system with ACE inhibitors or ARBs. Combination therapy with an ACE inhibitor and ARB or adding an MRA may provide additional benefits but also increase risks like hyperkalemia.
Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia. DM prevalence in Saudi Arabia is high at 23.7%. DM is diagnosed based on classic symptoms and elevated blood glucose levels. Prediabetes conditions like impaired fasting glucose and impaired glucose tolerance are risk factors for future diabetes and cardiovascular disease. Glycemic goals aim for an A1C below 7% and treatment involves medical nutrition therapy, oral medications, insulin, and preventing complications. Management of DM focuses on controlling blood glucose, blood pressure, lipids, and screening for and treating common complications.
The document discusses new trends in the management of diabetes in cardiac patients. It provides guidelines on glycemic targets and pharmacological therapy for type 2 diabetes. The recommended first-line treatment is metformin. Glycated hemoglobin (A1C) of less than 7% is a reasonable goal for many adults with diabetes, though some may require less or more stringent targets depending on individual factors. Combination therapy with oral medications and insulin is often needed to control blood sugar levels in type 2 diabetes.
- The prevalence of diabetes and prediabetes in India is estimated to be 9.3% and 24.5% respectively by 2022, with nearly half of those with diabetes unaware of their condition.
- Lifestyle interventions like achieving 7% weight loss through diet and exercise can reduce the risk of developing type 2 diabetes by 58%. Metformin and other drugs may also help prevent diabetes.
- Glycemic control is important and should be assessed regularly through A1C or other tests. An A1C under 7% is a reasonable goal for many adults to reduce health risks.
- Other comorbidities like hypertension, obesity, and kidney disease also need to be managed through lifestyle changes,
DKD is a leading cause of ESRD in the US, affecting 30-40% of those with diabetes. Poor glycemic control and hypertension are major risk factors for developing and progressing DKD. Clinical trials have shown that intensive control of blood glucose and blood pressure can delay and prevent kidney disease. New drugs targeting the kidney are showing promise in reducing albuminuria and slowing kidney function decline in DKD patients.
The document discusses the "glucose triad" which refers to the relationship between HbA1c, fasting plasma glucose, and postprandial plasma glucose in glycemic control. It notes that while HbA1c has traditionally been the target, more recent studies show intensive control to reach very low HbA1c levels may be detrimental. The document explores how the relationship between the components of the glucose triad changes over time as diabetes progresses, with postprandial glucose being more influential at lower HbA1c levels and fasting glucose becoming more important at higher levels. Treatment should target both fasting and postprandial hyperglycemia simultaneously for optimal control.
This document summarizes diabetic kidney disease (DKD), the leading cause of end-stage renal disease in the United States. DKD risk factors include age, sex, race, family history, hypertension, and poor glycemic control. Intensive glucose and blood pressure control can delay DKD progression. While current therapies can slow DKD, innovation is still needed to improve outcomes given residual risks. Novel drug classes targeting DKD mechanisms may provide future treatment options.
This document summarizes the history and mechanisms of action of SGLT2 inhibitors, a class of diabetes medications. Key points include:
- SGLT2 inhibitors work by blocking glucose reabsorption in the kidney, inducing glucosuria and lowering blood glucose levels.
- Several large clinical trials demonstrated SGLT2 inhibitors effectively lower HbA1c and blood glucose with a low risk of hypoglycemia compared to other diabetes medications.
- Beyond glycemic control, SGLT2 inhibitors provide additional benefits like weight loss, blood pressure reduction, and improved cardiac outcomes.
Type 2 dm gdm new updates & guidelinesSachin Verma
Type 2 diabetes is a multifactorial disorder characterised by progressive pancreatic beta-cell dysfunction and insulin- resistance, leading to relative insulin deficiency, chronic hyperglycaemia, and various complications.
The treatment options for this disorder, which aim at correcting one or other of the two major pathophysiological mechanisms, have been hamstrung by unacceptable side-effects, lack of patient acceptability, and loss of efficacy over time.
1) This case study describes a 60-year-old female patient with type 2 diabetes, hypertension, and dyslipidemia who is showing signs of declining kidney function and diabetic kidney disease.
2) Her HbA1c, blood pressure, lipids, and urine albumin levels have worsened over the past year despite treatment with metformin, glimepiride, and other medications.
3) Treatment options discussed include adding a DPP-4 inhibitor or SGLT2 inhibitor, or switching from glimepiride to gliclazide to help control blood sugar levels while avoiding further kidney damage and hypoglycemia. Gliclazide is presented as a safer option compared to other sulf
This document presents a case study of a 53-year-old African American woman (Patient A) with a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia who presents with shortness of breath, pruritus, and leg edema. Laboratory tests show abnormal kidney and liver function as well as poor diabetes control. The likely diagnosis is diabetic nephropathy based on her medical history and test results. Treatment goals should focus on improving blood pressure and glucose control as well as reducing albuminuria through medication changes and lifestyle modifications.
This document presents a case study of a 53-year-old African American woman (Patient A) with a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia who presents with shortness of breath, pruritus, and leg edema. Laboratory tests show abnormal kidney and liver function as well as poor diabetes control. The likely diagnosis is diabetic nephropathy based on her medical history and test results. Treatment goals should focus on improving blood pressure and glucose control as well as reducing albuminuria through medication changes and lifestyle modifications.
This document summarizes type 2 diabetes, including its pathophysiology, signs and symptoms, diagnosis, management goals, and treatment approaches. Type 2 diabetes is characterized by hyperglycemia due to insulin resistance and inadequate insulin secretion. Diagnosis is based on elevated blood glucose levels. Treatment goals are to reduce risks of microvascular and macrovascular complications through control of glycemia, blood pressure, lipids, and other factors. Common drug treatments include metformin, sulfonylureas, and other classes that work to lower blood glucose levels by various mechanisms. Lifestyle modifications and ongoing monitoring are also important for management.
Diabetic nephropathy medical managementNilesh Jadhav
1. Diabetic nephropathy is a chronic kidney disease caused by damage to the kidneys over many years as a result of diabetes. It is the most common cause of end-stage renal disease.
2. Management of diabetic nephropathy focuses on optimal control of blood glucose, blood pressure, lipids through medication, lifestyle changes, and monitoring for progression of kidney disease.
3. RAAS blockade using ACE inhibitors, ARBs, or renin inhibitors is important treatment but requires monitoring of potassium and kidney function. Referral to a nephrologist is recommended for atypical cases or rapid decline in kidney function.
This executive summary provides guidelines for diagnosis and management of diabetes and prevention of type 2 diabetes. Key points include:
1) Current criteria for diagnosing diabetes include an A1C of 6.5% or higher, a fasting plasma glucose of 126 mg/dl or higher, or a 2-hour plasma glucose of 200 mg/dl or higher during an oral glucose tolerance test.
2) To prevent type 2 diabetes, patients with prediabetes should be referred to lifestyle programs promoting weight loss through diet and exercise.
3) Self-monitoring of blood glucose is recommended for patients using insulin injections or pumps multiple times daily and may help guide success of non-insulin therapies. Continuous glucose monitoring can help lower A
This executive summary provides guidelines for the diagnosis and management of diabetes and includes the following key points:
1) It outlines criteria for diagnosing diabetes based on A1C, FPG, and OGTT test results.
2) It recommends screening and lifestyle interventions to prevent type 2 diabetes in those with prediabetes.
3) It provides guidelines for medical nutrition therapy, physical activity, smoking cessation, weight management, and glycemic targets to manage diabetes.
4) It addresses diabetes self-management education, immunizations, comorbid conditions like hypertension, and psychosocial care of people with diabetes.
1) A phase 3 clinical trial evaluated the efficacy and safety of sotagliflozin, a dual SGLT1/SGLT2 inhibitor, as an adjunct to insulin in 1,405 patients with type 1 diabetes.
2) Patients receiving sotagliflozin in addition to insulin had a greater percentage achieving the primary endpoint of an HbA1c level <7% without severe hypoglycemia or DKA compared to the placebo group (28.6% vs 15.2%).
3) However, sotagliflozin was also associated with a higher risk of DKA, particularly in patients using insulin pumps, despite intensive monitoring and insulin dose adjustments during the trial.
This document discusses diabetes mellitus (DM), including the main types of DM (type 1, type 2, gestational, monogenic), pathogenesis, clinical manifestations, complications, diagnosis, prediabetes, and metabolic syndrome. It defines the diagnostic criteria and thresholds for DM and prediabetes using fasting plasma glucose, oral glucose tolerance test, and A1C levels. Key recommendations are provided for diagnosing DM and prediabetes.
This study compared the efficacy and safety of canagliflozin (100mg and 300mg) to glimepiride as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin. Over 52 weeks, both doses of canagliflozin were found to be non-inferior to glimepiride in reducing HbA1c, with 300mg demonstrating superiority. Canagliflozin provided greater reductions in body weight and fasting plasma glucose compared to glimepiride and a lower risk of hypoglycemia. While genital and urinary infections were more common with canagliflozin, it offered cardiovascular benefits including blood pressure reduction without increased heart rate.
Diabetic nephropathy is a clinical syndrome characterized by the following :
Persistent albuminuria (>300 mg/d or >200 μg/min) that is confirmed on at least 2 occasions 3-6 months apart.
Progressive decline in the glomerular filtration rate (GFR).
Elevated arterial blood pressure.
Three major histologic changes occur in the glomeruli of persons with diabetic nephropathy:
First, mesangial expansion is directly induced by hyperglycemia, perhaps via increased matrix production or glycation of matrix proteins.
Second, thickening of the glomerular basement membrane (GBM) occurs.
Third, glomerular sclerosis caused by intraglomerular hypertension (induced by dilatation of the afferent renal artery or from ischemic injury induced by hyaline narrowing of the vessels supplying the glomeruli).
These different histologic patterns appear to have similar prognostic significance.
Several issues are key in the medical care of patients with diabetic nephropathy.
These include glycemic control, management of hypertension, and reducing dietary salt intake and phosphorus and potassium restriction in advanced cases.
A meta-analysis from the Cochrane Database shows a large fall in blood pressure with salt restriction, similar to that of single-drug therapy
DR. Wedad Bardisi DM Saudi Guideline.pptxFayzaRayes
Diabetes is a serious and growing problem in Saudi Arabia. Studies show prevalence rates of 23-34% and costs of $3,686 more per person with diabetes annually. Guidelines recommend screening those over 40 every 3 years or those at high risk. Treatment begins with lifestyle changes and metformin, adding other oral drugs or insulin as needed to reach an A1C target of 7%. Insulin therapy is often required long-term for type 2 diabetes control. Low-dose aspirin is recommended for cardiovascular protection depending on age and risk factors.
DR. Wedad Bardisi DM Saudi Guideline.pptxFayzaRayes
Diabetes is a serious and growing problem in Saudi Arabia. Studies show prevalence of diabetes in Saudi Arabia is around 23-34%, and costs associated with diabetes and its complications place a significant burden on the healthcare system. The guidelines provide recommendations for screening, diagnosing, and managing diabetes through lifestyle changes and pharmacologic treatment. The guidelines recommend metformin as initial treatment and emphasize individualizing treatment based on patient factors. Glycemic targets of A1C <7% and fasting blood glucose 70-130 mg/dL are provided.
This document provides an overview of diabetes mellitus (DM), including the different types of DM, pathophysiology, clinical presentation, diagnosis, treatment goals, and pharmacotherapy options. It discusses type 1 DM, type 2 DM, and gestational diabetes. For type 2 DM, it outlines non-pharmacologic treatment including lifestyle changes and describes pharmacologic options including metformin, sulfonylureas, and insulin therapy. The goals of treatment for type 2 DM are also summarized.
The document provides clinical practice guidelines for managing diabetes in patients with chronic kidney disease. It recommends:
- Treating patients with SGLT2 inhibitors and RAS inhibition to control blood pressure and slow kidney disease progression.
- Maintaining glycemic control, blood pressure control, lipid management, exercise, nutrition, and smoking cessation for all patients.
- Considering aspirin and dual antiplatelet therapy for some patients based on cardiovascular risk factors.
- Individualizing treatment based on disease severity, comorbidities, and life expectancy.
American Diabetes Association clinical practice recommendations 2012DJ CrissCross
1. The document outlines new clinical practice recommendations from the American Diabetes Association for 2012 regarding diagnosis, treatment, and management of diabetes.
2. It provides updated criteria for diagnosing diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests.
3. The recommendations address screening asymptomatic individuals and those with risk factors, managing gestational diabetes, preventing and delaying type 2 diabetes, glucose monitoring, glycemic goals, and treating hypertension, dyslipidemia, and complications of diabetes.
Lesi¢n renal aguda asociada e inducida por contraste.pptxOdalina Marrero
Este documento resume la nefropatía aguda inducida por contraste (NIC), incluyendo su definición, epidemiología, patogénesis, factores de riesgo, presentación clínica, diagnóstico, prevención y tratamiento. La NIC ocurre poco después de la administración de contraste yodado y se caracteriza por un aumento leve y temprano de la creatinina sérica. Los factores de riesgo incluyen la edad avanzada, enfermedad renal previa, diabetes, volumen de contraste y uso de agentes de alta
Este documento describe los diferentes tipos de diálisis peritoneal, incluyendo las modalidades intermitentes como la diálisis peritoneal nocturna y la diálisis peritoneal intermitente, las modalidades continuas como la diálisis peritoneal continua cíclica y la diálisis peritoneal continua ambulatoria, y factores a considerar como las características del paciente y la función renal residual. Se discuten las ventajas e inconvenientes de cada modalidad con el objetivo de realizar una prescripción individualizada.
This document summarizes diabetic kidney disease (DKD), the leading cause of end-stage renal disease in the United States. DKD risk factors include age, sex, race, family history, hypertension, and poor glycemic control. Intensive glucose and blood pressure control can delay DKD progression. While current therapies can slow DKD, innovation is still needed to improve outcomes given residual risks. Novel drug classes targeting DKD mechanisms may provide future treatment options.
This document summarizes the history and mechanisms of action of SGLT2 inhibitors, a class of diabetes medications. Key points include:
- SGLT2 inhibitors work by blocking glucose reabsorption in the kidney, inducing glucosuria and lowering blood glucose levels.
- Several large clinical trials demonstrated SGLT2 inhibitors effectively lower HbA1c and blood glucose with a low risk of hypoglycemia compared to other diabetes medications.
- Beyond glycemic control, SGLT2 inhibitors provide additional benefits like weight loss, blood pressure reduction, and improved cardiac outcomes.
Type 2 dm gdm new updates & guidelinesSachin Verma
Type 2 diabetes is a multifactorial disorder characterised by progressive pancreatic beta-cell dysfunction and insulin- resistance, leading to relative insulin deficiency, chronic hyperglycaemia, and various complications.
The treatment options for this disorder, which aim at correcting one or other of the two major pathophysiological mechanisms, have been hamstrung by unacceptable side-effects, lack of patient acceptability, and loss of efficacy over time.
1) This case study describes a 60-year-old female patient with type 2 diabetes, hypertension, and dyslipidemia who is showing signs of declining kidney function and diabetic kidney disease.
2) Her HbA1c, blood pressure, lipids, and urine albumin levels have worsened over the past year despite treatment with metformin, glimepiride, and other medications.
3) Treatment options discussed include adding a DPP-4 inhibitor or SGLT2 inhibitor, or switching from glimepiride to gliclazide to help control blood sugar levels while avoiding further kidney damage and hypoglycemia. Gliclazide is presented as a safer option compared to other sulf
This document presents a case study of a 53-year-old African American woman (Patient A) with a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia who presents with shortness of breath, pruritus, and leg edema. Laboratory tests show abnormal kidney and liver function as well as poor diabetes control. The likely diagnosis is diabetic nephropathy based on her medical history and test results. Treatment goals should focus on improving blood pressure and glucose control as well as reducing albuminuria through medication changes and lifestyle modifications.
This document presents a case study of a 53-year-old African American woman (Patient A) with a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia who presents with shortness of breath, pruritus, and leg edema. Laboratory tests show abnormal kidney and liver function as well as poor diabetes control. The likely diagnosis is diabetic nephropathy based on her medical history and test results. Treatment goals should focus on improving blood pressure and glucose control as well as reducing albuminuria through medication changes and lifestyle modifications.
This document summarizes type 2 diabetes, including its pathophysiology, signs and symptoms, diagnosis, management goals, and treatment approaches. Type 2 diabetes is characterized by hyperglycemia due to insulin resistance and inadequate insulin secretion. Diagnosis is based on elevated blood glucose levels. Treatment goals are to reduce risks of microvascular and macrovascular complications through control of glycemia, blood pressure, lipids, and other factors. Common drug treatments include metformin, sulfonylureas, and other classes that work to lower blood glucose levels by various mechanisms. Lifestyle modifications and ongoing monitoring are also important for management.
Diabetic nephropathy medical managementNilesh Jadhav
1. Diabetic nephropathy is a chronic kidney disease caused by damage to the kidneys over many years as a result of diabetes. It is the most common cause of end-stage renal disease.
2. Management of diabetic nephropathy focuses on optimal control of blood glucose, blood pressure, lipids through medication, lifestyle changes, and monitoring for progression of kidney disease.
3. RAAS blockade using ACE inhibitors, ARBs, or renin inhibitors is important treatment but requires monitoring of potassium and kidney function. Referral to a nephrologist is recommended for atypical cases or rapid decline in kidney function.
This executive summary provides guidelines for diagnosis and management of diabetes and prevention of type 2 diabetes. Key points include:
1) Current criteria for diagnosing diabetes include an A1C of 6.5% or higher, a fasting plasma glucose of 126 mg/dl or higher, or a 2-hour plasma glucose of 200 mg/dl or higher during an oral glucose tolerance test.
2) To prevent type 2 diabetes, patients with prediabetes should be referred to lifestyle programs promoting weight loss through diet and exercise.
3) Self-monitoring of blood glucose is recommended for patients using insulin injections or pumps multiple times daily and may help guide success of non-insulin therapies. Continuous glucose monitoring can help lower A
This executive summary provides guidelines for the diagnosis and management of diabetes and includes the following key points:
1) It outlines criteria for diagnosing diabetes based on A1C, FPG, and OGTT test results.
2) It recommends screening and lifestyle interventions to prevent type 2 diabetes in those with prediabetes.
3) It provides guidelines for medical nutrition therapy, physical activity, smoking cessation, weight management, and glycemic targets to manage diabetes.
4) It addresses diabetes self-management education, immunizations, comorbid conditions like hypertension, and psychosocial care of people with diabetes.
1) A phase 3 clinical trial evaluated the efficacy and safety of sotagliflozin, a dual SGLT1/SGLT2 inhibitor, as an adjunct to insulin in 1,405 patients with type 1 diabetes.
2) Patients receiving sotagliflozin in addition to insulin had a greater percentage achieving the primary endpoint of an HbA1c level <7% without severe hypoglycemia or DKA compared to the placebo group (28.6% vs 15.2%).
3) However, sotagliflozin was also associated with a higher risk of DKA, particularly in patients using insulin pumps, despite intensive monitoring and insulin dose adjustments during the trial.
This document discusses diabetes mellitus (DM), including the main types of DM (type 1, type 2, gestational, monogenic), pathogenesis, clinical manifestations, complications, diagnosis, prediabetes, and metabolic syndrome. It defines the diagnostic criteria and thresholds for DM and prediabetes using fasting plasma glucose, oral glucose tolerance test, and A1C levels. Key recommendations are provided for diagnosing DM and prediabetes.
This study compared the efficacy and safety of canagliflozin (100mg and 300mg) to glimepiride as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin. Over 52 weeks, both doses of canagliflozin were found to be non-inferior to glimepiride in reducing HbA1c, with 300mg demonstrating superiority. Canagliflozin provided greater reductions in body weight and fasting plasma glucose compared to glimepiride and a lower risk of hypoglycemia. While genital and urinary infections were more common with canagliflozin, it offered cardiovascular benefits including blood pressure reduction without increased heart rate.
Diabetic nephropathy is a clinical syndrome characterized by the following :
Persistent albuminuria (>300 mg/d or >200 μg/min) that is confirmed on at least 2 occasions 3-6 months apart.
Progressive decline in the glomerular filtration rate (GFR).
Elevated arterial blood pressure.
Three major histologic changes occur in the glomeruli of persons with diabetic nephropathy:
First, mesangial expansion is directly induced by hyperglycemia, perhaps via increased matrix production or glycation of matrix proteins.
Second, thickening of the glomerular basement membrane (GBM) occurs.
Third, glomerular sclerosis caused by intraglomerular hypertension (induced by dilatation of the afferent renal artery or from ischemic injury induced by hyaline narrowing of the vessels supplying the glomeruli).
These different histologic patterns appear to have similar prognostic significance.
Several issues are key in the medical care of patients with diabetic nephropathy.
These include glycemic control, management of hypertension, and reducing dietary salt intake and phosphorus and potassium restriction in advanced cases.
A meta-analysis from the Cochrane Database shows a large fall in blood pressure with salt restriction, similar to that of single-drug therapy
DR. Wedad Bardisi DM Saudi Guideline.pptxFayzaRayes
Diabetes is a serious and growing problem in Saudi Arabia. Studies show prevalence rates of 23-34% and costs of $3,686 more per person with diabetes annually. Guidelines recommend screening those over 40 every 3 years or those at high risk. Treatment begins with lifestyle changes and metformin, adding other oral drugs or insulin as needed to reach an A1C target of 7%. Insulin therapy is often required long-term for type 2 diabetes control. Low-dose aspirin is recommended for cardiovascular protection depending on age and risk factors.
DR. Wedad Bardisi DM Saudi Guideline.pptxFayzaRayes
Diabetes is a serious and growing problem in Saudi Arabia. Studies show prevalence of diabetes in Saudi Arabia is around 23-34%, and costs associated with diabetes and its complications place a significant burden on the healthcare system. The guidelines provide recommendations for screening, diagnosing, and managing diabetes through lifestyle changes and pharmacologic treatment. The guidelines recommend metformin as initial treatment and emphasize individualizing treatment based on patient factors. Glycemic targets of A1C <7% and fasting blood glucose 70-130 mg/dL are provided.
This document provides an overview of diabetes mellitus (DM), including the different types of DM, pathophysiology, clinical presentation, diagnosis, treatment goals, and pharmacotherapy options. It discusses type 1 DM, type 2 DM, and gestational diabetes. For type 2 DM, it outlines non-pharmacologic treatment including lifestyle changes and describes pharmacologic options including metformin, sulfonylureas, and insulin therapy. The goals of treatment for type 2 DM are also summarized.
The document provides clinical practice guidelines for managing diabetes in patients with chronic kidney disease. It recommends:
- Treating patients with SGLT2 inhibitors and RAS inhibition to control blood pressure and slow kidney disease progression.
- Maintaining glycemic control, blood pressure control, lipid management, exercise, nutrition, and smoking cessation for all patients.
- Considering aspirin and dual antiplatelet therapy for some patients based on cardiovascular risk factors.
- Individualizing treatment based on disease severity, comorbidities, and life expectancy.
American Diabetes Association clinical practice recommendations 2012DJ CrissCross
1. The document outlines new clinical practice recommendations from the American Diabetes Association for 2012 regarding diagnosis, treatment, and management of diabetes.
2. It provides updated criteria for diagnosing diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests.
3. The recommendations address screening asymptomatic individuals and those with risk factors, managing gestational diabetes, preventing and delaying type 2 diabetes, glucose monitoring, glycemic goals, and treating hypertension, dyslipidemia, and complications of diabetes.
Lesi¢n renal aguda asociada e inducida por contraste.pptxOdalina Marrero
Este documento resume la nefropatía aguda inducida por contraste (NIC), incluyendo su definición, epidemiología, patogénesis, factores de riesgo, presentación clínica, diagnóstico, prevención y tratamiento. La NIC ocurre poco después de la administración de contraste yodado y se caracteriza por un aumento leve y temprano de la creatinina sérica. Los factores de riesgo incluyen la edad avanzada, enfermedad renal previa, diabetes, volumen de contraste y uso de agentes de alta
Este documento describe los diferentes tipos de diálisis peritoneal, incluyendo las modalidades intermitentes como la diálisis peritoneal nocturna y la diálisis peritoneal intermitente, las modalidades continuas como la diálisis peritoneal continua cíclica y la diálisis peritoneal continua ambulatoria, y factores a considerar como las características del paciente y la función renal residual. Se discuten las ventajas e inconvenientes de cada modalidad con el objetivo de realizar una prescripción individualizada.
La diálisis peritoneal como opción dialítica.pptxOdalina Marrero
El documento compara diferentes modalidades de tratamiento renal como la diálisis peritoneal, hemodiálisis y trasplante renal. Señala que la diálisis peritoneal y la hemodiálisis no son competitivas sino complementarias, y que no hay diferencias en la supervivencia de los pacientes. Además, la diálisis peritoneal conserva mejor la función renal residual y tiene un coste-utilidad más favorable que la hemodiálisis.
Indicaciones y uso correcto del hierro y ePO.pptxOdalina Marrero
Este documento resume las indicaciones y uso correcto del hierro y los agentes estimulantes de la eritropoyesis (EPO) en pacientes con hemodiálisis. Describe los beneficios del tratamiento de la anemia, los criterios para iniciar el tratamiento con hierro y EPO, las dosis recomendadas y los niveles objetivos de hemoglobina. También discute los posibles efectos adversos y las causas de resistencia a la EPO. El objetivo general es mejorar los síntomas de la anemia y reducir la morbilidad y mortalidad asociadas a
Este documento describe diferentes tipos de diuréticos, incluyendo diuréticos de asa, tiazidas, diuréticos ahorradores de potasio y antagonistas de la hormona antidiurética. Explica sus usos para tratar afecciones como hipertensión, insuficiencia cardíaca y nefrolitiasis, así como sus posibles efectos secundarios como hipercalemia, acidosis metabólica e hiponatremia.
Este documento proporciona una definición y clasificación de la lesión renal aguda (AKI), así como información sobre su epidemiología, factores de riesgo, fisiopatología, manejo y pronóstico. La AKI puede ser prerrenal, intrarenal o postrenal, y sus causas incluyen enfermedades críticas, sepsis, choque circulatorio, fármacos nefrotóxicos y condiciones obstructivas. El diagnóstico se basa en los niveles de creatinina, la diuresis y el anális
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptxgoluk9330
Ahota Beel, nestled in Sootea Biswanath Assam , is celebrated for its extraordinary diversity of bird species. This wetland sanctuary supports a myriad of avian residents and migrants alike. Visitors can admire the elegant flights of migratory species such as the Northern Pintail and Eurasian Wigeon, alongside resident birds including the Asian Openbill and Pheasant-tailed Jacana. With its tranquil scenery and varied habitats, Ahota Beel offers a perfect haven for birdwatchers to appreciate and study the vibrant birdlife that thrives in this natural refuge.
(June 12, 2024) Webinar: Development of PET theranostics targeting the molecu...Scintica Instrumentation
Targeting Hsp90 and its pathogen Orthologs with Tethered Inhibitors as a Diagnostic and Therapeutic Strategy for cancer and infectious diseases with Dr. Timothy Haystead.
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...Sérgio Sacani
Context. The observation of several L-band emission sources in the S cluster has led to a rich discussion of their nature. However, a definitive answer to the classification of the dusty objects requires an explanation for the detection of compact Doppler-shifted Brγ emission. The ionized hydrogen in combination with the observation of mid-infrared L-band continuum emission suggests that most of these sources are embedded in a dusty envelope. These embedded sources are part of the S-cluster, and their relationship to the S-stars is still under debate. To date, the question of the origin of these two populations has been vague, although all explanations favor migration processes for the individual cluster members. Aims. This work revisits the S-cluster and its dusty members orbiting the supermassive black hole SgrA* on bound Keplerian orbits from a kinematic perspective. The aim is to explore the Keplerian parameters for patterns that might imply a nonrandom distribution of the sample. Additionally, various analytical aspects are considered to address the nature of the dusty sources. Methods. Based on the photometric analysis, we estimated the individual H−K and K−L colors for the source sample and compared the results to known cluster members. The classification revealed a noticeable contrast between the S-stars and the dusty sources. To fit the flux-density distribution, we utilized the radiative transfer code HYPERION and implemented a young stellar object Class I model. We obtained the position angle from the Keplerian fit results; additionally, we analyzed the distribution of the inclinations and the longitudes of the ascending node. Results. The colors of the dusty sources suggest a stellar nature consistent with the spectral energy distribution in the near and midinfrared domains. Furthermore, the evaporation timescales of dusty and gaseous clumps in the vicinity of SgrA* are much shorter ( 2yr) than the epochs covered by the observations (≈15yr). In addition to the strong evidence for the stellar classification of the D-sources, we also find a clear disk-like pattern following the arrangements of S-stars proposed in the literature. Furthermore, we find a global intrinsic inclination for all dusty sources of 60 ± 20◦, implying a common formation process. Conclusions. The pattern of the dusty sources manifested in the distribution of the position angles, inclinations, and longitudes of the ascending node strongly suggests two different scenarios: the main-sequence stars and the dusty stellar S-cluster sources share a common formation history or migrated with a similar formation channel in the vicinity of SgrA*. Alternatively, the gravitational influence of SgrA* in combination with a massive perturber, such as a putative intermediate mass black hole in the IRS 13 cluster, forces the dusty objects and S-stars to follow a particular orbital arrangement. Key words. stars: black holes– stars: formation– Galaxy: center– galaxies: star formation
Anti-Universe And Emergent Gravity and the Dark UniverseSérgio Sacani
Recent theoretical progress indicates that spacetime and gravity emerge together from the entanglement structure of an underlying microscopic theory. These ideas are best understood in Anti-de Sitter space, where they rely on the area law for entanglement entropy. The extension to de Sitter space requires taking into account the entropy and temperature associated with the cosmological horizon. Using insights from string theory, black hole physics and quantum information theory we argue that the positive dark energy leads to a thermal volume law contribution to the entropy that overtakes the area law precisely at the cosmological horizon. Due to the competition between area and volume law entanglement the microscopic de Sitter states do not thermalise at sub-Hubble scales: they exhibit memory effects in the form of an entropy displacement caused by matter. The emergent laws of gravity contain an additional ‘dark’ gravitational force describing the ‘elastic’ response due to the entropy displacement. We derive an estimate of the strength of this extra force in terms of the baryonic mass, Newton’s constant and the Hubble acceleration scale a0 = cH0, and provide evidence for the fact that this additional ‘dark gravity force’ explains the observed phenomena in galaxies and clusters currently attributed to dark matter.
Evidence of Jet Activity from the Secondary Black Hole in the OJ 287 Binary S...Sérgio Sacani
Wereport the study of a huge optical intraday flare on 2021 November 12 at 2 a.m. UT in the blazar OJ287. In the binary black hole model, it is associated with an impact of the secondary black hole on the accretion disk of the primary. Our multifrequency observing campaign was set up to search for such a signature of the impact based on a prediction made 8 yr earlier. The first I-band results of the flare have already been reported by Kishore et al. (2024). Here we combine these data with our monitoring in the R-band. There is a big change in the R–I spectral index by 1.0 ±0.1 between the normal background and the flare, suggesting a new component of radiation. The polarization variation during the rise of the flare suggests the same. The limits on the source size place it most reasonably in the jet of the secondary BH. We then ask why we have not seen this phenomenon before. We show that OJ287 was never before observed with sufficient sensitivity on the night when the flare should have happened according to the binary model. We also study the probability that this flare is just an oversized example of intraday variability using the Krakow data set of intense monitoring between 2015 and 2023. We find that the occurrence of a flare of this size and rapidity is unlikely. In machine-readable Tables 1 and 2, we give the full orbit-linked historical light curve of OJ287 as well as the dense monitoring sample of Krakow.
TOPIC OF DISCUSSION: CENTRIFUGATION SLIDESHARE.pptxshubhijain836
Centrifugation is a powerful technique used in laboratories to separate components of a heterogeneous mixture based on their density. This process utilizes centrifugal force to rapidly spin samples, causing denser particles to migrate outward more quickly than lighter ones. As a result, distinct layers form within the sample tube, allowing for easy isolation and purification of target substances.
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆Sérgio Sacani
Context. The early-type galaxy SDSS J133519.91+072807.4 (hereafter SDSS1335+0728), which had exhibited no prior optical variations during the preceding two decades, began showing significant nuclear variability in the Zwicky Transient Facility (ZTF) alert stream from December 2019 (as ZTF19acnskyy). This variability behaviour, coupled with the host-galaxy properties, suggests that SDSS1335+0728 hosts a ∼ 106M⊙ black hole (BH) that is currently in the process of ‘turning on’. Aims. We present a multi-wavelength photometric analysis and spectroscopic follow-up performed with the aim of better understanding the origin of the nuclear variations detected in SDSS1335+0728. Methods. We used archival photometry (from WISE, 2MASS, SDSS, GALEX, eROSITA) and spectroscopic data (from SDSS and LAMOST) to study the state of SDSS1335+0728 prior to December 2019, and new observations from Swift, SOAR/Goodman, VLT/X-shooter, and Keck/LRIS taken after its turn-on to characterise its current state. We analysed the variability of SDSS1335+0728 in the X-ray/UV/optical/mid-infrared range, modelled its spectral energy distribution prior to and after December 2019, and studied the evolution of its UV/optical spectra. Results. From our multi-wavelength photometric analysis, we find that: (a) since 2021, the UV flux (from Swift/UVOT observations) is four times brighter than the flux reported by GALEX in 2004; (b) since June 2022, the mid-infrared flux has risen more than two times, and the W1−W2 WISE colour has become redder; and (c) since February 2024, the source has begun showing X-ray emission. From our spectroscopic follow-up, we see that (i) the narrow emission line ratios are now consistent with a more energetic ionising continuum; (ii) broad emission lines are not detected; and (iii) the [OIII] line increased its flux ∼ 3.6 years after the first ZTF alert, which implies a relatively compact narrow-line-emitting region. Conclusions. We conclude that the variations observed in SDSS1335+0728 could be either explained by a ∼ 106M⊙ AGN that is just turning on or by an exotic tidal disruption event (TDE). If the former is true, SDSS1335+0728 is one of the strongest cases of an AGNobserved in the process of activating. If the latter were found to be the case, it would correspond to the longest and faintest TDE ever observed (or another class of still unknown nuclear transient). Future observations of SDSS1335+0728 are crucial to further understand its behaviour. Key words. galaxies: active– accretion, accretion discs– galaxies: individual: SDSS J133519.91+072807.4
Signatures of wave erosion in Titan’s coastsSérgio Sacani
The shorelines of Titan’s hydrocarbon seas trace flooded erosional landforms such as river valleys; however, it isunclear whether coastal erosion has subsequently altered these shorelines. Spacecraft observations and theo-retical models suggest that wind may cause waves to form on Titan’s seas, potentially driving coastal erosion,but the observational evidence of waves is indirect, and the processes affecting shoreline evolution on Titanremain unknown. No widely accepted framework exists for using shoreline morphology to quantitatively dis-cern coastal erosion mechanisms, even on Earth, where the dominant mechanisms are known. We combinelandscape evolution models with measurements of shoreline shape on Earth to characterize how differentcoastal erosion mechanisms affect shoreline morphology. Applying this framework to Titan, we find that theshorelines of Titan’s seas are most consistent with flooded landscapes that subsequently have been eroded bywaves, rather than a uniform erosional process or no coastal erosion, particularly if wave growth saturates atfetch lengths of tens of kilometers.
3. Epidemiología
USA
● 34 millones de personas con DM
● DM causa #01 de fallo renal
● CVD #01 morbimortalidad
● Control glicemico, hipoglicemia, dieta,
peso, ejercicio
EL control glucémico ralentiza el desarrollo de ECV y ERC.
4. Caso Clínico #01
Un hombre de 65 años con una historia de 9 años de
diabetes tipo 2 tiene una hemoglobina A1c (HbA1c) del
8,7%. Su médico de atención primaria lo remitió para hablar
sobre el manejo de su diabetes. Está tomando gliburida a
10 mg diarios y metformina a 1000 mg dos veces al día
junto con candesartán y atorvastatina. En el examen, su
índice de masa corporal (IMC) es de 29 kg / m2, su presión
arterial (PA) es de 138/78 mm Hg y tiene evidencia de
neuropatía periférica. Tiene una tasa de filtración
glomerular estimada (TFGe) de 33 ml / min / 1,73 m2 y
una relación albúmina-creatinina en orina (UACR) de 317
mg / g. Lo primero que discute con él es su objetivo de
HbA1c.
5. Pregunta 1: ¿Cuál de los siguientes objetivos de HbA1c es apropiado para este paciente?
● a) <6,0%
● b) <7,0%
● c) <8,0%
● d) <9,0%
6. Pregunta 2: ¿Cuál de las siguientes opciones es correcta con
respecto a las mediciones de HbA1c en este paciente?
a) La HbA1c se vuelve inexacta para evaluar la glucemia cuando la eGFR es <60 ml /
min / 1,73 m2.
b) La albúmina glicada es preferible a la HbA1c cuando evaluar la glucemia durante los
últimos 3 meses.
c) Cuando la eGFR es <30 mL / min / 1.73 m2, la HbA1c mide 0.5% a 1.0% más baja
de que deberían.
d) Pacientes con proteinuria en rango nefrótico y la albúmina baja tienen medidas
inexactas tanto de albúmina glucosilada como de HbA1c.
7. <6,5% (AACE)
pacientes sanos
con bajo riesgo de
hipoglucemia
Adultos no
embarazadas es
≤ 7%.
Pacientes con
esperanza de vida
más corta,
antecedentes de
hipoglucemia
grave,
comorbilidades
extensas y
complicaciones
avanzadas es ≤
8%.
También reconocen que estos objetivos deben individualizarse.
Objetivo de HbA1c según la ADA
8. (HbA1c 7.2% vs 9.1%)
disminuyó el desarrollo de
albuminuria y la proporción de
pacientes que desarrollan ERC
en estadio 3 en la diabetes tipo
1.
Disminución de la ERC de
nueva aparición, así como
la progresión de la
nefropatía con un control
glucémico intensivo.
No mostraron reducción de
la ECV con un control
glucémico más intensivo
(6,4% vs 7,5% en
ACCORD
6,3% vs 7,3% en
ADVANCE
6,9% vs 8,4% en VADT).
9. Objetivo de HbA1c sea inferior al 7,0% en lugar del 6,5%.
Se asocian con mejores resultados renales y microvasculares,
pero también con un aumento de la hipoglucemia.
En general, un objetivo de HbA1c de ~ 7,0% parece ofrecer
una relación riesgo-beneficio óptima en comparación con
un objetivo más bajo.
Si un objetivo más bajo mostraría una mejor relación riesgo-
beneficio general si solo se desconocieran los medicamentos
que no causan hipoglucemia.
10.
11. KDOQI en 2007 sobre la
diabetes y la ERC aprobó una
HbA1c de <7,0%
En 2012 recomendaba una
HbA1c de ~ 7,0%.
KDIGO señaló que no hay datos
suficientes de ensayos clínicos
con respecto al objetivo ideal de
control glucémico en pacientes
con ERC en estadio 3 o peor.
Pacientes en TRS se benefician
más de mantener sus niveles de
HbA1c en el rango del 7% al
8%, ya que los niveles de
HbA1c por encima del 8% o por
debajo del 7% conllevan
mayores riesgos de todas las
causas y Mortalidad por ECV.
Por lo tanto, para la pregunta 1, la mejor respuesta es (c), una meta de HbA1c <8%.
Sin embargo, si el paciente no está tomando ningún medicamento que pueda causar
hipoglucemia, se podría considerar una HbA1c <7%.
12. ● HbA1c cada 6 meses en personas con un control glucémico estable que esté en el objetivo;
● cada 3 meses si no se está cumpliendo la meta glucémica o si se han producido cambios en el
tratamiento.
● .
● La medición de HbA1c puede ser inexacta en algunos pacientes con ERC cuando la eGFR se
acerca a 30 ml / min / 1,73 m2 y menos (estadios 4-5 de ERC).
● albúmina glucosilada proporciona una estimación del control glucémico durante las 2 semanas
anteriores.
● Algunos estudios han demostrado que la albúmina glucosilada es mejor que la HbA1c en
pacientes en diálisis porque la HbA1c tiende a subestimar el control glucémico evaluado por la
monitorización continua de la glucosa (MCG) en pacientes en diálisis de mantenimiento.
● Sin embargo, para evaluar el control a largo plazo, la HbA1c sigue siendo la medida de elección
porque quedan dudas sobre la albúmina glucosilada en relación con su precisión y variabilidad
entre laboratorios, así como cuando los niveles de albúmina sérica son particularmente bajos
cuando los pacientes tienen síndrome nefrótico.
● Además, la HbA1c refleja 3 meses de control glucémico versus solo 2 semanas para la albúmina
glucosilada.
13. ● When the eGFR is < 30 mL/min/1.73 m , the HbA1c
● measures 0.5% to 1.0% lower than it should; a rule-of-
● thumb estimate could be to add this amount to the
● measured HbA1 c to get an idea of the “true” HbA1 c .
● Thus, for question 2, because the patient is now near
● stage 4 CKD, because glycated albumin only measures
● glycemic control for the prior 2 weeks and not 3
● months, and because nephrotic-range albuminuria does
● not affect HbA1c, the best answer is (c), a reduction of 0.5%-1.0% occurs in those with eGFR
< 30 mL/min/ 2
● 1.73 m . Multiple daily blood glucose measurements are critical in such patients when
insulin is used to assess glycemic control and avoid hypoglycemia.
16. GLP1
● Subcutaneo
● Estimula la liberacion de
insulina dependiente de
glucosa
● Disminuye la secrecion del
glucagon
● Retrasa el vaciamiento gastrico
● Suprime el apetito
● Perdida de peso
Desciende HB1AC 0.5-1.5%
Pancreatitis (no alto riesgo en comparacion con los demas)
Nauseas
Tumores de tiroides de celulas C (en animales)
No causa hipoglicemia (al menos que este combinado)
Byetta cada 12 h
Victoza cada 24h
Ozempic cada semana
Trulicity cada semana
Adlyxin cada 24 h
exenatide extended-release (Bydureon)
Semaglutide is also now available as an oral preparation (Rybelsus).
Degludec/liraglutide (Xultophy)
glargine/lixisenatide (Soliqua).
17. The LEADER, SUSTAIN-6, and REWIND studies showed significant reductions in CVD mortality
with liraglutide, semaglutide, and dulaglutide, respectively, along with reductions in the
development of severe albuminuria but no effects on GFR.
However, the REWIND study with dulaglutide showed a benefit on eGFR as a secondary outcome.
Neither CVD nor CKD benefits were seen with extended-release exenatide or lixisenatide.
18. ● With declines in GFR, exenatide clearance decreases. Cases of acute kidney injury (AKI)
associated with exenatide use have been reported, so caution is warranted in patients with
GFR of 30-50 mL/min/1.73 m2; exenatide 2 should be discontinued for GFR < 30
mL/min/1.73 m .
● No dose adjustment is needed for liraglutide in CKD, including kidney failure, although data
are limited. However, due to some reports of AKI, caution is warranted 2
when GFR is <30 mL/min/1.73 m .
● No dosage restrictions are required with decreasing GFR for dulaglutide or semaglutide.
Due to lack of data, lixisenatide should not be used if the GFR < 15 mL/min/1.73 m , and
close monitoring is needed in patients with eGFR < 60 mL/ min/1.73 m .
● Thus, for question 3, the best answer is (a), liraglutide has been shown to reduce
cardiovascular deaths. Weight loss can be significant but does not approach 20%.
Liraglutide has not been shown to cause pancreatic cancer or worsening of kidney
function.
19. Metformina
● Mejora la sensibilidad a la insulina
● Disminuye la produccion hepatica de glucosa
● No causa hipoglicemia
● Reduce Hb1Ac 1.0-1.5%
● Diarrea
● Bloating Limita el uso en el 15% de los pacientes
● Abdominal crampring
● Deficiencia de Vitamina B12
● GFR baja, aumenta el riesgo de acidosis lactica (GFR is < 30 mL/min/1.73 m )
20. Summarized by Inzucchi et al (2014), the risk of lactic acidosis in metformin users
increases from 7.6 (95% CI, 0.9-27.5) per 100,000 patient-years among patients with a
normal eGFR to 39 (95% CI, 4.72-140.89) per 100,000 .
he revised US Food and Drug Administration (FDA)
guidelines state that metformin should not be used in
patients with an eGFR < 30 mL/min/1.73 m2 and suggest
that metformin should not be started for eGFR of 30- 45
mL/min/1.73 m . Furthermore, if the eGFR drops below
45 mL/min/1.73 m2 in The course of treatment, the risks
and benefits of continuing metformin should be reviewed
because of the increasing probability of further decrease.
It has been recommended also That the maximum
metformin dose should be reduced to no more than 1,000
mg/d with an eGFR < 45 mL/min/1.73 m .
It is important to hold metformin when a patient is
unstable such as being in a hypoxic,
hypotensive, or septic state or after iodinated contras
administration until it is clear that there is no long-term
decrease in GFR.
21. Sulfonilureas y glinidas
● Sulfonilureas aumenta la secrecion de insulina
● Hb1Ac 1.0-2.0%
● Puede causar hipoglicemia (gliburida clorpropamida)
● GFR baja, aumenta el riesgo de hipoglicemia
● With an eGFR < 60 mL/min/1.73 m , the risk of
hypoglycemia is greatly increased with glyburide and
is moderada con glimepiride
● Glyburide should not be used with an eGFR < 60
mL/min/1.73 m
● Glimepiride should be used with caution if the eGFR
is < 60 mL/min/1.73 m2 and should be discontinued if
eGFR is < 30 mL/min/1.73 m
Glucose must be present for them to work, and they
themselves have a short half-life and cause a quick
insulin release of short duration; therefore, they should be
given before each meal.
22. Thiazolidinediones
● Aumenta la sensibilidad a la insulina
● No causa hipoglicemia
● Hb1AC 0.5-1.4%
● Retencion de liquido (No ICC)
● Asociado a fractura en ratas y perdida osea (ojo con pacientes con osteodistrofia)
● No es aclarada por el riñon (se pueden utilizar en ERC )
23. Inhibidores de α-Glucosidase
● Disminuye digestion de carbohidratos
● Retrasa la absorcion de glucosa despues de las comidas(reduce glucosa
postprandial)
● Bloating
● Flatulencias
● Abdominal cramping
● Hb1Ac 0.5-0.8%
● Beneficio cardiovascular y CKD
24. DPP4
● Inhibidores de la dipeptidil
peptidasa
● Disminuye la lisis de las hormonas
de incretinas como GLP1 y GIP
glucosa insulinotropico peptido
● Neutro con el peso
● No causa hipoglicemia
● HbA1c 0.5-0.8%
● Todos pueden ser utilizados y todos
necesitan ajuste, excelto linagliptina
● No Beneficio cardiovascular no CKD
25. iSGLT2
● Reduce la absorcion de glucosa en el
tubulo proximal, provocando
glucosuria
● Hb1Ac 0.5-1.0%
● Perdida de peso 5kg en 1 año
● No causan hipoglicemia
● 10% infecciones genitales mujeres
● 1-2% en hombres no circuncidado
● IVU
● Some older patients may experience
orthostatic hypotension with drug
initiation, especially if they are also
taking diuretics; diuretic doses should
be reduced when starting these drugs.
● creased risk for the development of
“euglycemic” diabetic ketoacidosis
(DKA), primarily when used off-label in
patients with type 1 diabetes but also
26. ● Significant reduction of cardiovascular outcomes (espe- cially heart failure), slower kidney
disease progression, and fewer renal events (such as kidney replacement therapy initiation)
with empagliflozin use were shown in the EMPA-
27. La lesión renal aguda (AKI, acute kidney
injury), conocida antes como
insuficiencia renal aguda.
Lesión renal aguda ≠ insuficiencia renal aguda
Uptodate
28. Definición
Fracaso renal agudo
Deficiencia repentina de la
función renal que origina la
retención de productos
nitrogenados y otros desechos
que en circunstancias normales
son eliminados por los riñones.
Uptodate
31. • IRA no constituye una
sola enfermedad.
• Es un diagnóstico
clínico
Bun, Creatinina,
Diuresis
Puede ir desde cuadro asintomático hasta
cuadro rápidamente mortal.
Uptodate
34. Epidemiología
• 20% hospitalizaciones
• 10% amerita TRS
• 30% de admisiones en UCI
• Ha aumentado mas de
cuatro veces y se ha
calculado que tiene una
incidencia anual de 500
casos por 1 000 personas
• Mortalidad de 50% en los
que ameritan TRS
• 70% prerrenal, 20%
intrarenal, 10% postrenal
Uptodate
38. La enfermedad
prerrenal y la necrosis
tubular aguda
(NTA). Juntos,
representan
aproximadamente del
65 al 75 por ciento de
los casos de AKI
39. Prerrenal
• 70% de FRA adquirido en la comunidad
• 40% de los adquiridos en el hospital
• Es reversible
• Si se mantiene 48-72 horas--- NTA isquémica
• Disminución perfusión
• Aumenta: Angiotensina II, aldosterona, ADH
• Se debe suspender bloqueantes sistema RAA
Uptodate
44. Intrarrenal
20% de FRA
adquirido en la
comunidad
Causa mas
importante
adquirido en el
hospital
Vascular,
glomerular o
tubulointersticial
Directa (isquemia,
toxinas endógenas,
exógenas)
Indirecta
(estructuras
parenquimatosas,
glomérulo, vasos,
tubulointersticial)
Obstrucción
Intratubular
Duración media
12-15 días, puede
resolver en 30 dias
Uptodate
45. Septicemia
Daño endotelial que origina
trombosis microvascular,
activación de especies
reactivas de oxigeno y
adhesión y migración
leucocitica, factores todos
que pueden dañar las
células tubulares de los
riñones.
Isquemia
Uptodate
49. Distinción de la enfermedad
prerrenal de la necrosis tubular
aguda
Análisis de
orina.
Respuesta a la
repleción de
líquidos
Excreción
fraccionada
de sodio
(FENa)
Gold estándar
24-72hrs
Uptodate
50. La excreción fraccional de
concentración de sodio y la orina
de sodio
• Variabilidad no especifica de la tasa de excreción
de sodio (ADH, poca absorción en NTA)
UNa x SCr
FENa, porcentaje = ——————— x 100
SNa x UCr
1% prerrenal
> 2% en la NTA
Uptodate
51. Limitaciones de la excreción fraccionada
de sodio
La FENa puede permanecer por debajo
del 1 por ciento cuando la ATN se
superpone a una enfermedad prerrenal
crónica como cirrosis o insuficiencia
cardíaca, o en una minoría de pacientes
con ATN posisquémica (isquémica) no
oligúrica que pueden tener isquemia
renal persistente y ATN menos grave.
Una FENa por debajo del 1 por ciento
no es exclusiva de la enfermedad
prerrenal, ya que puede ocurrir con
otras causas de AKI que están
asociadas con una TFG baja y una
función tubular relativamente
intacta. Estos incluyen glomerulonefritis
aguda, vasculitis, rabdomiólisis y
nefropatía inducida por contraste.
Uptodate
52. Postrrenal
• 10-15% de FRA adquirido en la comunidad
• Hiperplasia benigna causa mas común
hombres de 60 años
Uptodate
59. ● Historia clínica
● Examen físico
● Manifestacione
s
● Determinación de
la duración de la
enfermedad
● Estimación de la
tasa de filtración
glomerular
● Análisis de orina
● El volumen de
orina
● Imagenes
● Pruebas
serológicas y
función de la
Uptodate
62. Los sujetos con AKI tienen
mayor propensión a fallecer en
forma prematura después de
que son dados de alta del
hospital, e incluso después de
haber recuperado
su función renal.
Uptodate
66. Treatment
Do you know what helps you make your
point clear? Lists like this one:
● They’re simple
● You can organize your ideas
clearly
● You’ll never forget to buy milk!
And the most important thing: the
audience won’t miss the point of your
presentation
67. Our Team
John James
Here you can talk a
bit about this
person
Jenna Doe
Here you can talk a
bit about this
person
Jim Patterson
Here you can talk a
bit about this
person
68. This Is a Table
Mass
(earths)
Diameter
(earths)
Surface
Gravity
(earths)
Mercury 0.06 0.38 0.38
Mars 0.11 0.53 0.38
Saturn 95.2 9.4 1.16
69. A Timeline Always Works Well
Mercury
Mercury is the
smallest planet
Jupiter
Jupiter is the
biggest planet
Neptune
Neptune is the
farthest planet
Mars
Mars is a very
cold place
01 02 03 04
71. Sneak Peek
Mercury
You can replace the image on
the screen with your own
work. Just delete this one, add
yours and center it properly
72. CREDITS: This presentation template was created by
Slidesgo, including icon by Flaticon, and infographics &
images from Freepik
Thanks!
Do you have any questions?
addyouremail@freepik.com
+91 620 421 838
yourcompany.com
Please keep this slide for attribution
73. Resources
Photos
● Close-up of young female athlete
having pain in her waist
● Long shot nurse helping old woman
with her coat
Vectors
● Abstract painted business card
template
● Set of people donating blood
● How the covid-19 rapid test works
● Health professional team in medical
robes
● Health professional team
● Training at home concept
● Qr code scan on mobile concept
● Elders and young people in crowded
space wearing mask
Icons
● Kidneys
● Ultrasound
74. Instructions for use (free users)
In order to use this template, you must credit Slidesgo by keeping the
Thanks slide.
You are allowed to:
● Modify this template.
● Use it for both personal and commercial purposes.
You are not allowed to:
● Sublicense, sell or rent any of Slidesgo Content (or a modified version of Slidesgo Content).
● Distribute this Slidesgo Template (or a modified version of this Slidesgo Template) or include it in a database or in
any other product or service that offers downloadable images, icons or presentations that may be subject to
distribution or resale.
● Use any of the elements that are part of this Slidesgo Template in an isolated and separated way from this
Template.
● Delete the “Thanks” or “Credits” slide.
● Register any of the elements that are part of this template as a trademark or logo, or register it as a work in an
intellectual property registry or similar.
For more information about editing slides, please read our FAQs or visit Slidesgo School:
https://slidesgo.com/faqs and https://slidesgo.com/slidesgo-school
75. Instructions for use (premium users)
In order to use this template, you must be a Premium user on Slidesgo.
You are allowed to:
● Modify this template.
● Use it for both personal and commercial purposes.
● Hide or delete the “Thanks” slide and the mention to Slidesgo in the credits.
● Share this template in an editable format with people who are not part of your team.
You are not allowed to:
● Sublicense, sell or rent this Slidesgo Template (or a modified version of this Slidesgo Template).
● Distribute this Slidesgo Template (or a modified version of this Slidesgo Template) or include it in a database or in
any other product or service that offers downloadable images, icons or presentations that may be subject to
distribution or resale.
● Use any of the elements that are part of this Slidesgo Template in an isolated and separated way from this
Template.
● Register any of the elements that are part of this template as a trademark or logo, or register it as a work in an
intellectual property registry or similar.
For more information about editing slides, please read our FAQs or visit Slidesgo School:
https://slidesgo.com/faqs and https://slidesgo.com/slidesgo-school
76. Fonts & colors used
This presentation has been made using the following fonts:
Patua One
(https://fonts.google.com/specimen/Patua+One)
Cairo
(https://fonts.google.com/specimen/Cairo)
#6d9c8b #b3c9da #f86c6c
#ffc6c6 #f8eddd #fff9f0
77. Storyset
Create your Story with our illustrated concepts. Choose the style you like the most, edit its colors, pick
the background and layers you want to show and bring them to life with the animator panel! It will boost
your presentation. Check out How it Works.
Pana Amico Bro Rafiki Cuate
78. You can easily resize these resources without losing quality. To change the color, just ungroup the resource
and click on the object you want to change. Then, click on the paint bucket and select the color you want.
Group the resource again when you’re done. You can also look for more infographics on Slidesgo.
Use our editable graphic resources...
79.
80.
81. JANUARY FEBRUARY MARCH APRIL MAY JUNE
PHASE 1
PHASE 2
Task 1
Task 2
Task 1
Task 2
JANUARY FEBRUARY MARCH APRIL
PHASE 1
Task 1
Task 2
87. ...and our sets of editable icons
You can resize these icons without losing quality.
You can change the stroke and fill color; just select the icon and click on the paint
bucket/pen.
In Google Slides, you can also use Flaticon’s extension, allowing you to
customize and add even more icons.